Comparison of the Effect of and Compliance With Cyclosporine 0.1% After Various Pretreatments in Dry Eye Disease

<b>Purpose:</b> We sought to compare the effect of cyclosporine 0.1% after various pretreatments in patients with dry eye disease. <b>Methods:</b> Two hundred seventy-four eyes of 137 patients diagnosed with dry eye disease were retrospectively enrolled. Thirty patients (Group 1, 60 eyes) were not pretreated, while 68 patients (Group 2, 136 eyes) were pretreated with fluorometholone 0.1%, and 39 patients (Group 3, 78 eyes) were pretreated with cyclosporine 0.05% before treatment with cyclosporine 0.1%. The Ocular Surface Disease Index Questionnaire (OSDI) score, Schirmer I test result, noninvasive tear film break-up time (NItBUT), corneal staining score, matrix metalloproteinase-9 (MMP-9) grade, meibography result, meibum quality and expressibility scores, and tear meniscus height were examined before treatment and at 1, 2, and 3 months after treatment. <b>Results:</b> All dry eye signs and symptoms of all Groups at 1, 2, and 3 months were significantly improved compared to those before treatment with cyclosporine 0.1% (<i>p</i> < 0.05). Notably, the OSDI score, Schirmer I test result, NItBUT, corneal and conjunctival fluorescein score, and MMP-9 grade in Group 3 were significantly improved compared to those in Groups 1 and 2 at 1, 2, and 3 months after treatment with cyclosporine 0.1% (<i>p</i> < 0.05). The percentages of cases with treatment discontinuation in Groups 1, 2, and 3 were 20.0%, 7.4%, and 10.0%, respectively. <b>Conclusion:</b> Pretreatment with cyclosporine 0.05% can augment the anti-inflammatory effect of cyclosporine 0.1%. Pretreatment with a steroid or a lower concentration of cyclosporine can increase compliance in patients using a cyclosporine 0.1% eye drop.